Shoulder Pain

The most common reasons for shoulder replacement surgery are chronic pain and restricted movement.

Your shoulder is the most mobile joint in your entire body, which allows you the freedom to perform everyday tasks, like getting dressed and brushing your hair. However, with chronic shoulder pain, these tasks can be extremely limited.

What’s causing your pain?

Arthritis

Arthritis can develop from tearing or dislocating your rotator cuff, fracturing your shoulder, an autoimmune disease, or simply wear and tear over a period of time. There are several different types of arthritis. Osteoarthritis, post-traumatic arthritis, and rheumatoid arthritis are the ones that most commonly affect the shoulder. Arthritis causes your cartilage to break down, which causes the ball and socket of your shoulder joint to rub against each other. This can be quite painful and leads to some swelling and a limited range of motion. Shoulder replacement surgery should be recommended when lack of mobility and pain reach an advanced point.

Symptoms

  • Pain with activities.
  • Limited range of motion.
  • Stiffness of the shoulder.
  • Swelling of the joint.
  • Tenderness around the joint.
  • A feeling of grinding or catching within the joint.

What’s causing your pain?

Torn Rotator Cuff

Rotator cuff tears are common, especially after the age of 40. The tendons that make up the rotator cuff continually weaken as we grow older, making them much more likely to tear when we fall or perform repetitive overhead activities, like swimming and weightlifting. When a torn rotator cuff is not repaired, the shoulder cannot move the way it is supposed to which causes wear and tear on the joint. As time passes, arthritis develops and the function of the rotator cuff may be lost entirely, resulting in cuff tear arthropathy.

Symptoms

  • Pain around and in your shoulder
  • Pain when lifting or rotating your arm
  • Pain worsens at night when sleeping on your shoulder
  • Limited movement (trouble performing everyday tasks, like brushing hair)

With larger rotator cuff tears that cannot be repaired and rotator cuff arthropathy, reverse shoulder replacement is commonly recommended.

What’s causing your pain?

Shoulder Fracture

A shoulder fracture can be caused by a car crash, a fall, or contact sports. It involves one of the three shoulder bones: scapula, humerus, or clavicle. The most common fracture is a break in the “ball” of the shoulder joint, or proximal humerus fracture. These breaks are very common in older people with low-impact falls due to their poor bone density (osteoporosis). Shoulder fractures are often treated without surgery, however with this break where the bones are displaced from their normal position, surgery might be recommended. This may involve the realignment of the bones and holding them in place with nails, plates, and screws. When this cannot be performed, shoulder replacement surgery may be recommended.

What’s causing your pain?

Shoulder Dislocations

Shoulder dislocations commonly occur when you try to “catch” your fall with an outstretched arm. This can force the humerus to shift out of the socket and move towards the front of the body. After dislocating the shoulder once, you are at a higher risk of having more dislocations. The rotator cuff may also tear when the dislocation occurs. If the rotator cuff cannot be repaired or is torn completely, shoulder replacements might be recommended.

There are three common ways that a shoulder can become unstable.

  • Shoulder dislocation — SThis is usually caused by severe injury or trauma to the shoulder. When the head of the humerus (ball) dislocates, the glenoid (socket) and the ligaments in the front of the shoulder are regularly injured. Said torn ligament is generally called a Bankart lesion. Severely dislocating can lead to continuous dislocations, giving out, or a consistent feeling of instability.
  • Repetitive strain — SSome patients with shoulder instability have never experienced a dislocation. A lot of these patients have looser ligaments, which might be their normal anatomy or it could be the result of repetitive overhead motion. This happens during specific jobs or sports, like swimming, volleyball and tennis. These looser ligaments make it harder to uphold shoulder stability, especially with stressful activities. This can result in pain and a feeling of instability.
  • Multidirectional Instability — This occurs in a small minority of patients, where the shoulder can become unstable without a lot of injury or repetitive strain. The shoulder might feel loose or could dislocate in a number of directions (out the front, back or bottom of the shoulder), which is called multidirectional instability. These patients naturally have looser ligaments throughout their bodies and might also be double-jointed.

Symptoms

  • A visibly deformed or out-of-place shoulder.
  • Swelling or bruising.
  • Intense pain.
  • Inability to move the joint.

Shoulder Anatomy

Bones of the Shoulder

Your shoulder is a ball and socket joint. The ball (humeral head) is at the top of the humerus, the long bone that runs from your shoulder down to your elbow. This fits into the socket (glenoid), which is formed by your scapula and clavicle. A soft tissue called articular cartilage covers the ball and socket. This allows the movement of your shoulder to be pain-free.

Rotator Cuff

Your rotator cuff is made up of four muscles that form a tendon cuff over the humeral head, or “ball” of your shoulder. This allows you to lift and rotate your arm and move your shoulder in different directions. It also helps the ball stay in the center of the socket.